A Bump in the Road

Pregnancy is not always a blissful time, especially for women who suffer from emotional illnesses such as depression, anxiety or an eating disorder. Untreated, these conditions can have serious consequences for both mom and baby. Here, experts—as well as mothers who’ve been there—share their solutions.

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Blissful. Joyful. Glowing. These are words that typically describe moms-to-be. But what about the other possibilities: blue, anxious, pregorexic? Pregnant women’s struggles may slowly be coming out of the closet, but many moms-to-be still suffer in silence with emotional issues, and the majority are never diagnosed or treated. The result can be problematic for their babies as well as themselves.

Many OBs don’t screen for mental health issues, and a lot of expectant women don’t reveal their problems to their doctors, says Heather Flynn, Ph.D., an associate professor and director of the women’s mental health program at the University of Michigan Medical School’s department of psychiatry. “Women attribute what they’re feeling to hormonal shifts, and many fear they’ll be judged,” she says. Those who are diagnosed often don’t seek treatment because they’re afraid to take medication, think their symptoms are normal or lack the time and money for care.

Experts blame the emotional extremes on wildly shifting pregnancy hormones combined with the physical, social and even existential challenges that come with pregnancy—a changing body shape, a new identity as a mom and fears of being responsible for a child. Some women are blindsided by a sudden onset, but in many cases, pregnancy triggers an exacerbation of a condition they were already dealing with. (See “When Problems Are Pre-Existing,” to learn how pregnancy affects bipolar, panic, obsessive-compulsive and post-traumatic stress disorders.)

Left untreated, psychological ills during pregnancy are linked to an increased risk of prenatal and delivery complications, a greatly increased risk of postpartum depression, and possible cognitive and behavioral issues in children down the road. So whether you have borderline symptoms or a full-blown problem, don’t suffer in silence: Help is available. Here’s how some mothers coped with their emotional issues during pregnancy and what the experts recommend.

PRE-BABY BLUES

Depression“I felt really sad, had no energy and fell into this strange state where I thought, ‘What’s the point of anything?’ ’’ Kelly Judge, 32, an orchestra teacher in Kirkwood, Mo., describes herself as an extremely happy, positive person. About two weeks after she found out she was pregnant with her second child, Judge felt her good mood disappear. “I had a fabulous marriage, a wonderful 3-year-old, no financial stress, the pregnancy was planned, so life should have been great,” she recalls. “But I felt really sad, had no energy and fell into this strange state where I thought, ‘What’s the point of anything?’ ”

At the same time, Judge began to feel very anxious, but not about anything in particular. Caring for her child or keeping the house in order became difficult. After several weeks, she called her OB. “I knew that this was not me and that something was wrong,” she says. Her OB referred her to a psychologist, whom she began to see regularly. Judge also started taking the antidepressant Lexapro. Within weeks, her mood lifted.

Judge gave birth to a healthy baby girl in January. Her daughter shows none of the possible side effects of the antidepressant, and Judge is staying on the drug until she’s out of the postpartum woods, albeit reluctantly. “I was fortunate that I was able to recognize that something was wrong and was not afraid to ask for help,” she says.

Why it happens} An estimated 14 percent to 23 percent of moms-to-be experience serious (clinical) depression, and about 40 percent have some symptoms. It may be set off by the steep rise in pregnancy hormones, worries about the life changes a new baby will bring, or both.

The signs} Feeling sad for several weeks; loss of interest in activities you normally enjoy; feelings of guilt or hopelessness; difficulty concentrating. You can take a self-test called the Edinburgh Postnatal Depression Scale, aap.org/ practicingsafety/toolkit_resources/module2/epds.pdf, which is used to screen for prenatal depression as well; you should also talk to your doctor or midwife.

Who’s most at risk} Women who have suffered from depression or anxiety in the past, especially during pregnancy, or had postpartum depression (PPD) or a family history of depression (the mother, in particular); women with a low income or poor social support.

Risks of not treating} Increased risk of preeclampsia, preterm delivery, having a low birth-weight baby or one with low Apgar scores, and PPD; poor cognitive, neurologic and motor skill development and long-term behavioral effects in children.

What works} Many expectant women are reluctant to take antidepressants because of concerns that the drugs may harm their babies (see “Are Antidepressants Safe During Pregnancy?”), but drugs aren’t your only option: Depression-specific psychotherapies, such as cognitive behavioral therapy, have been shown to be just as effective in treating mild to moderate cases.